Healthcare Provider Details

I. General information

NPI: 1366350647
Provider Name (Legal Business Name): VILLAGE AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MARKET ST STE E
FRIDAY HARBOR WA
98250-7937
US

IV. Provider business mailing address

PO BOX 370
FRIDAY HARBOR WA
98250-0370
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-2857
  • Fax: 360-378-2856
Mailing address:
  • Phone: 360-378-2857
  • Fax: 360-378-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN ANTHONY WAMBSGANSS
Title or Position: FINANCE DIRECTOR/TREASURER
Credential:
Phone: 360-378-2857